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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Size of aneurysm matters in subarachnoid hemorrhage

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  • Thomas Sauvigny - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Nils Ole Schmidt - University hospital Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Neurosurgery, Hamburg, Deutschland
  • Jan Regelsberger - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Patrick Czorlich - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.11.07

doi: 10.3205/17dgnc434, urn:nbn:de:0183-17dgnc4347

Published: June 9, 2017

© 2017 Sauvigny et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The Hunt&Hess (H&H) grade is still one of the best scores to assess disease severity and neurological outcome in subarachnoid hemorrhage (SAH). However, the question remains, which biological factors determine the severity of SAH. Previous studies analyzing the amount of blood and the size of the ruptured aneurysm showed inhomogeneous results. Here, we present an analysis of a large prospective database. We hypothesize that the H&H grade at presentation correlates with preexisting biological factors such as aneurysm size.

Methods: All patients from 10/2010 to 03/2016 with proven aneurysmal SAH were included in this study. Detailed clinical characteristics were compared with regard to the assessed H&H grade using a multivariate regression analysis. Outcome was measured via the Glasgow Outcome Scale (GOS) at discharge. Analyses were calculated using SPSS v.23 and MATLAB R2014b. Probability values of p<0.05 were considered significant.

Results: 371 patients (240 females, 64.7%) with a mean age of 54.6±13.6 years (range 18-88) were analyzed in this study. The mean H&H grade was 2.75±1.4 (median=2). The diameter of the symptomatic aneurysm ranged from 0.7 mm to 37.0 mm with a mean of 7.3±5.4 mm. At discharge, 196 patients (52.8%) showed a favorable outcome (GOS 4-5), which was predicted by the H&H grade at presentation (p<0.001). Multivariate analysis revealed aneurysm size (p<0.001), age (p=0.001), a preexisting neurological disease (p=0.002) and abuse of alcohol (p=0.039) to differ significantly among the H&H grades. Among these parameters, aneurysm size had the strongest effect with a partial eta squared (η2p) of 0.118 followed by age (η2p=0.053). Sex, number and location of aneurysms, hypertension, diabetes, body mass index, use of platelet inhibitors, anticoagulation and smoking showed no difference regarding the H&H grade at presentation.

Conclusion: We could identify preexisting biological and life style conditions, which were associated with disease severity in SAH. The size of the aneurysm and age seemed to have the strongest impact on the risk of a higher H&H grade. Since age is an immutable parameter, further functional analyses of the biological characteristics of aneurysm size seem a promising tool to understand the clinical severity of SAH.